Reusable and Disposable Incontinence Underpads: Environmental Footprints as a Route for Decision Making to Decarbonize Health Care.

BACKGROUND: Objectives of quality principles in the clinical setting present nursing with opportunities for quality patient care but at lower environmental footprint. This affects patients, hospital personnel, and community because choices reduce climate change and thus support an innovative nursing role. PURPOSE: This article aims to support nursing knowledge to include environment in decisions regarding patient care and reusable versus disposable incontinence underpads (IUPs). METHODS: A life cycle analysis was conducted, including soiling, reusable cycles before removal, supply chains, laundry use, and end-of-life environmental impact. RESULTS: The selection of reusable IUPs versus disposables reduced total natural resource energy consumption by 71%, greenhouse gas emissions by 61%, blue water consumption by 57%, and solid waste by 97%. CONCLUSIONS: The nursing community can use this information in its health care organizations regarding IUP to advocate for decisions to select reusable IUPs that benefit our environment (air, water, and land).

Environmental impact reduction as a new dimension for quality measurement of healthcare services.

PURPOSE: The purpose of this paper is to provide a detailed accounting of energy and materials consumed during magnetic resonance imaging (MRI). DESIGN/METHODOLOGY/APPROACH: The first and second stages of ISO standard (ISO 14040:2006 and ISO 14044:2006) were followed to develop life cycle inventory (LCI). The LCI data collection took the form of observations, time studies, real-time metered power consumption, review of imaging department scheduling records and review of technical manuals and literature. FINDINGS: The carbon footprint of the entire MRI service on a per-patient basis was measured at 22.4 kg CO2eq. The in-hospital energy use (process energy) for performing MRI is 29 kWh per patient for the MRI machine, ancillary devices and light fixtures, while the out-of-hospital energy consumption is approximately 260 percent greater than the process energy, measured at 75 kWh per patient related to fuel for generation and transmission of electricity for the hospital, plus energy to manufacture disposable, consumable and reusable products. The actual MRI and standby energy that produces the MRI images is only about 38 percent of the total life cycle energy. RESEARCH LIMITATIONS/IMPLICATIONS: The focus on methods and proof-of-concept meant that only one facility and one type of imaging device technology were used to reach the conclusions. Based on the similar studies related to other imaging devices, the provided transparent data can be generalized to other healthcare facilities with few adjustments to utilization ratios, the share of the exam types, and the standby power of the facilities' imaging devices. PRACTICAL IMPLICATIONS: The transparent detailed life cycle approach allows the data from this study to be used by healthcare administrators to explore the hidden public health impact of the radiology department and to set goals for carbon footprint reductions of healthcare organizations by focusing on alternative imaging modalities. Moreover, the presented approach in quantifying healthcare services' environmental impact can be replicated to provide measurable data on departmental quality improvement initiatives and to be used in hospitals' quality management systems. ORIGINALITY/VALUE: No other research has been published on the life cycle assessment of MRI. The share of outside hospital indirect environmental impact of MRI services is a previously undocumented impact of the physician's order for an internal image.

A progressive pruritic rash with blisters.

This article describes a patient with a progressive pruritic rash and fluid-filled blisters. A punch biopsy later confirmed the diagnosis of bullous pemphigoid, an inflammatory condition that most commonly occurs in older adults and is treated with corticosteroids.

Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy.

BACKGROUND: Reducing low-value clinical care is an important strategy to mitigate environmental pollution caused by health care. OBJECTIVE: To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy. DESIGN, SETTING, AND PARTICIPANTS: We performed a cradle-to-grave life cycle assessment of prostate biopsy. Data included materials and energy inventory, patient and staff travel contributed by prostate MRI, transrectal ultrasound guided prostate biopsy, and pathology analysis. We compared environmental emissions across five clinical scenarios: multiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and systematic biopsies. We estimated the environmental impacts associated with reducing the overall number and varying the approach of a prostate biopsy by using MRI as a triage strategy or by omitting MRI. The study involved academic medical centers in the USA, outpatient urology clinics, health care facilities, medical staff, and patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Greenhouse gas emissions (CO2 equivalents, CO2e), and equivalents of coal and gasoline burned were measured. RESULTS AND LIMITATIONS: In the USA, a single transrectal prostate biopsy procedure including prostate MRI, and targeted and systematic biopsies emits an estimated 80.7 kg CO2e. An approach of MRI targeted cores alone without a systematic biopsy generated 76.2 kg CO2e, a systematic 12-core biopsy without mpMRI generated 36.2 kg CO2e, and bpMRI with targeted and systematic biopsies generated 70.5 kg CO2e; mpMRI alone contributed 42.7 kg CO2e (54.3% of baseline scenario). Energy was the largest contributor, with an estimated 38.1 kg CO2e, followed by staff travel (20.7 kg CO2e) and supply production (11.4 kg CO2e). Performing 100 000 fewer unnecessary biopsies would avoid 8.1 million kg CO2e, the equivalent of 4.1 million liters of gasoline consumed. Per 100 000 patients, the use of prostate MRI to triage prostate biopsy and guide targeted biopsy cores would save the equivalent of 1.4 million kg of CO2 emissions, the equivalent of 700 000 l of gasoline consumed. This analysis was limited to prostate MRI and biopsy, and does not account for downstream clinical management. CONCLUSIONS: A prostate biopsy contributes a calculable environmental footprint. Modifying or reducing the number of biopsies performed through existing evidence-based approaches would decrease health care pollution from the procedure. PATIENT SUMMARY: We estimated that prostate magnetic resonance imaging (MRI) with a prostate biopsy procedure emits the equivalent of 80.7 kg of carbon dioxide. Performing fewer unnecessary prostate biopsies or using prostate MRI as a tool to decide which patients should have a prostate biopsy would reduce procedural greenhouse gas emissions and health care pollution.

A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012.

Contemporary comparisons of reusable and single-use perioperative textiles (surgical gowns and drapes) reflect major changes in the technologies to produce and reuse these products. Reusable and disposable gowns and drapes meet new standards for medical workers and patient protection, use synthetic lightweight fabrics, and are competitively priced. In multiple science-based life cycle environmental studies, reusable surgical gowns and drapes demonstrate substantial sustainability benefits over the same disposable product in natural resource energy (200%-300%), water (250%-330%), carbon footprint (200%-300%), volatile organics, solid wastes (750%), and instrument recovery. Because all other factors (cost, protection, and comfort) are reasonably similar, the environmental benefits of reusable surgical gowns and drapes to health care sustainability programs are important for this industry. Thus, it is no longer valid to indicate that reusables are better in some environmental impacts and disposables are better in other environmental impacts. It is also important to recognize that large-scale studies of comfort, protection, or economics have not been actively pursued in the last 5 to 10 years, and thus the factors to improve both reusables and disposable systems are difficult to assess. In addition, the comparison related to jobs is not well studied, but may further support reusables. In summary, currently available perioperative textiles are similar in comfort, safety, and cost, but reusable textiles offer substantial opportunities for nurses, physicians, and hospitals to reduce environmental footprints when selected over disposable alternatives. Evidenced-based comparison of environmental factors supports the conclusion that reusable gowns and drapes offer important sustainability improvements. The benefit of reusable systems may be similar for other reusables in anesthesia, such as laryngeal mask airways or suction canisters, but life cycle studies are needed to substantiate these benefits.

National Economic and Environmental Benefit of Reusable Textiles in Cleanroom Industry.

In cleanroom facilities, both disposable and reusable textile garments (coveralls, boots, hoods, and frocks) meet the particulate standards from the most rigorous to the most basic levels. However, the reusables clearly offer two other important benefits, lower annual cost and lower environmental impact. The objectives of this article are to now provide quantitative reusable product benefits on a U.S. national environmental and economic basis. This is the first quantitative, novel multi-user economic evaluation of selecting cleanroom reusables over disposables. For personal protection equipment (PPE), these cost and environmental benefits indicate there is also an improved environmental and economic aspect to the increased national demand for reusables related to coronavirus disease 2019 (COVID-19), while necessary cleaning with approved detergents is easily achieved. The current reusable cleanroom market (14.1 million packages) was estimated to be 60% nonsterile and 40% sterilized. The total market is about 50% reusable and 50% disposable. This research documents that there is an annual cost reduction of about 58% when selecting reusables over disposables, giving an economic savings to the U.S. cleanroom sector from reusables of about $1.2 billion in the next decade. This is also saving the total U.S. about 136 million MJ natural resource energy/year (38 million kWh) and about 8.4 million kg CO2eq annually (removal of about 1,650 cars/year). A maximum hypothetical case for reusables at 87.5% of the market (12.5% are mandatory Hazmat disposable) would yield a U.S. national savings of nearly $2.1 billion/decade to the cleanroom sector bottom line, as well as 2.4 billion MJ nre savings in energy or removal of about 29,000 cars/decade. These results indicate there are effective, verifiable, and easily obtained environmental and economic benefits by the basic transition by diverse cleanrooms in deciding to select reusable garments.

Life Cycle Greenhouse Gas Emissions of Gastrointestinal Biopsies in a Surgical Pathology Laboratory.

OBJECTIVES: Given adverse health effects of climate change and contributions of the US health care sector to greenhouse gas (GHG) emissions, environmentally sustainable delivery of care is needed. We applied life cycle assessment to quantify GHGs associated with processing a gastrointestinal biopsy in order to identify emissions hotspots and guide mitigation strategies. METHODS: The biopsy process at a large academic pathology laboratory was grouped into steps. Each supply and reagent was catalogued and postuse treatment noted. Energy consumption was estimated for capital equipment. Two common scenarios were considered: 1 case with 1 specimen jar (scenario 1) and 1 case with 3 specimen jars (scenario 2). RESULTS: Scenario 1 generated 0.29 kg of carbon dioxide equivalents (kg CO2e), whereas scenario 2 resulted in 0.79 kg CO2e-equivalent to 0.7 and 2.0 miles driven, respectively. The largest proportion of GHGs (36%) in either scenario came from the tissue processor step. The second largest contributor (19%) was case accessioning, mostly attributable to production of single-use disposable jars. CONCLUSIONS: Applied to more than 20 million biopsies performed in the US annually, emissions from biopsy processing is equivalent to yearly GHG emissions from 1,200 passenger cars. Mitigation strategies may include modification of surveillance guidelines to include the number of specimen jars.

An Environmental Analysis of Reusable and Disposable Surgical Gowns.

Surgical gowns help protect patients from exposure to microorganisms and serve as personal protective equipment for perioperative staff members. Medical textiles, including surgical gowns, are available as reusable and disposable products. Health care facility administrators and leaders who endeavor to use environmentally sustainable practices require current data for decision making. This study analyzed all activities from the extraction of fossil materials from the earth to the end-of-life disposal of reusable and disposable surgical gowns. The researchers included calculations for laundry and wastewater treatment operations and compared the environmental effects of the two surgical gown systems. The study results showed that selection of reusable gowns rather than disposable gowns reduced natural resource energy consumption (64%), greenhouse gas emissions (66%), blue water consumption (83%), and solid waste generation (84%). Perioperative nurses can use this information to assist facility leaders as they make informed decisions related to gown system selection.

Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives.

BACKGROUND: Isolation gowns serve a critical role in infection control by protecting healthcare workers, visitors, and patients from the transfer of microorganisms and body fluids. The decision of whether to use a reusable or disposable garment system is a selection process based on factors including sustainability, barrier effectiveness, cost, and comfort. Environmental sustainability is increasingly being used in the decision-making process. Life cycle assessment is the most comprehensive and widely used tool used to evaluate environmental performance. METHODS: The environmental impacts of market-representative reusable and disposable isolation gown systems were compared using standard life cycle assessment procedures. The basis of comparison was 1,000 isolation gown uses in a healthcare setting. The scope included the manufacture, use, and end-of-life stages of the gown systems. RESULTS: At the healthcare facility, compared to the disposable gown system, the reusable gown system showed a 28% reduction in energy consumption, a 30% reduction in greenhouse gas emissions, a 41% reduction in blue water consumption, and a 93% reduction in solid waste generation. CONCLUSIONS: Selecting reusable garment systems may result in significant environmental benefits compared to selecting disposable garment systems. By selecting reusable isolation gowns, healthcare facilities can add these quantitative benefits directly to their sustainability scorecards.

Life Cycle Assessment of Reusable and Disposable Cleanroom Coveralls.

Cleanroom garments serve a critical role in such industries as pharmaceuticals, life sciences, and semiconductor manufacturing. These textiles are available in reusable and disposable alternatives. In this report, the environmental sustainability of cleanroom coveralls is examined using life cycle assessment technology. The complete supply chain, manufacture, use, and end-of-life phases for reusable and disposable cleanroom coveralls are compared on a cradle-to-end-of-life cycle basis. Three industry representative coveralls are examined: a reusable woven polyethylene terephthalate (PET) coverall, a disposable flash spunbonded high-density polyethylene (HDPE) coverall, and a disposable spunbond-meltblown-spunbond polypropylene (SMS PP) coverall. The reusable cleanroom coverall system shows substantial improvements over both disposable cleanroom coverall systems in all environmental impact categories. The improvements over the disposable HDPE coverall were 34% lower process energy (PE), 23% lower natural resource energy (NRE), 27% lower greenhouse gas (GHG) emissions, and 73% lower blue water consumption. The improvements over the disposable SMS PP coverall were 59% lower PE, 56% lower NRE, 57% lower GHG emissions, and 77% lower blue water consumption. In addition, the reusable system shows a 94-96% reduction in solid waste to the landfill from the cleanroom facility. Between the two disposable cleanroom coveralls, the flash spunbonded HDPE coverall shows a measurable environmental improvement over the SMS PP coverall.LAY ABSTRACT: Pharmaceutical drugs are manufactured and handled in controlled environments called cleanrooms to ensure the safety and quality of products. In order to maintain strict levels of cleanliness, cleanroom personnel are required to wear garments such as coveralls, hoods, and gloves that restrict the transfer of particles from the person to the environment. These garments are available in reusable and disposable types. Cleanroom operators consider a number of factors when selecting between reusable and disposable garments, including price, comfort, and environmental sustainability.In this report, the environmental sustainability of reusable and disposable cleanroom coveralls is examined using a technique called life cycle assessment. With this technique, environmental parameters such as energy use and greenhouse gas emissions are quantified and compared for three market representative cleanroom coveralls, from raw material extraction through manufacturing, use, and final disposal. Reusable coveralls were found to substantially outperform disposable coveralls in all environmental parameters examined. This is an important conclusion that supports cleanroom companies that select reusable coveralls to be more sustainable.

Beneficial reuse and sustainability: the fate of organic compounds in land-applied waste.

Land application systems, also referred to as beneficial reuse systems, are engineered systems that have defined and permitted application areas based on site and waste characteristics to determine the land area size requirement. These terrestrial systems have orders of magnitude greater microbial capability and residence time to achieve decomposition and assimilation compared with aquatic systems. In this paper we focus on current information and information needs related to terrestrial fate pathways in land treatment systems. Attention is given to conventional organic chemicals as well as new estrogenic and pharmaceutical chemicals of commerce. Specific terrestrial fate pathways addressed include: decomposition, bound residue formation, leaching, runoff, and crop uptake. Molecular decomposition and formation of bound residues provide the basis for the design and regulation of land treatment systems. These mechanisms allow for assimilation of wastes and nondegradation of the environment and accomplish the goal of sustainable land use. Bound residues that are biologically produced are relatively immobile, degrade at rates similar to natural soil materials, and should present a significantly reduced risk to the environment as opposed to parent contaminants. With regard to leaching and runoff pathways, no comprehensive summary or mathematical model of organic chemical migration from land treatment systems has been developed. For the crop uptake pathway, a critical need exists to develop information for nonagricultural chemicals and to address full-scale performance and monitoring at more land application sites. The limited technology choices for treatment of biosolids, liquids, and other wastes implies that acceptance of some risks and occurrence of some benefits will continue to characterize land application practices that contribute directly to the goal of beneficial reuse and sustainability.

Scope for energy improvement for hospital imaging services in the USA.

OBJECTIVE: To aid radiologists by measuring the carbon footprint of CT scans by quantifying in-hospital and out-of-hospital energy use and to assess public health impacts. METHOD: The study followed a standard life cycle assessment protocol to measure energy from a CT scan then expanding to all hospital electrical energy related to CT usage. In addition, all the fuel energy used to generate electricity and to manufacture the CT consumables was measured. The study was conducted at two hospitals. RESULTS: The entire life cycle energy for a CT scan was 24-34 kWh of natural resource energy per scan. The actual active patient scan energy that produces the images is only about 1.6% of this total life cycle energy. This large multiplier to get total CT energy is a previously undocumented environmental response to the direct radiology order for a patient CT scan. The CT in-hospital energy related to idle periods, where the machine is on but no patients are being scanned and is 14-30-fold higher than the energy used for the CT image. The in-hospital electrical energy of a CT scan makes up only about 25% of the total energy footprint. The rest is generated outside the hospital: 54-62% for generation and transmission of the electricity, while 13-22% is for all the energy to make the consumables. Different CT scanners have some influences on the results and could help guide purchase of CT equipment. CONCLUSIONS: The transparent, detailed life cycle approach allows the data from this study to be used by radiologists to examine details of both direct and of unseen energy impacts of CT scans. The public health (outside-the-hospital) impact (including the patients receiving a CT) needs to be measured and included.

Cradle-to-gate life cycle inventory of vancomycin hydrochloride.

A life cycle analysis on the cradle-to-gate production of vancomycin hydrochloride, which begins at natural resource extraction and spans through factory (gate) production, not only shows all inputs, outputs, and energy usage to manufacture the product and all related supply chain chemicals, but can highlight where process changes would have the greatest impact on raw material and energy consumption and emissions. Vancomycin hydrochloride is produced by a low-yield fermentation process that accounts for 47% of the total cradle-to-gate energy. The fermentation step consumes the most raw materials and energy cradle-to-gate. Over 75% of the total cradle-to-gate energy consumption is due to steam use; sterilization within fermentation is the largest user of steam. Aeration and agitation in the fermentation vessels use 65% of the cradle-to-gate electrical energy. To reduce raw materials, energy consumption, and the associated environmental footprint of producing vancomycin hydrochloride, other sterilization methods, fermentation media, nutrient sources, or synthetic manufacture should be investigated. The reported vancomycin hydrochloride life cycle inventory is a part of a larger life cycle study of the environmental consequences of the introduction of biocide-coated medical textiles for the prevention of MRSA (methicillin-resistant Staphylococcus aureus) nosocomial infections.